Countries: Benin and Ghana
Year: 2011 and vaccine introduction period

There is limited up-to-date knowledge of the full economic cost of routine immunization. Some data exist but are mainly focused on resource requirement projections.
In this context, AMP conducted a study in Benin and Ghana from 2011 to 2013 to calculate the costs of routine immunization, to evaluate financing flows, to calculate incremental costs of new vaccine introduction, to evaluate financing of new vaccine introduction activities, and to assess the determinants of cost of health facilities as well as their productivity.

This study was part of a larger project called “Analyses of the Costs and Financing of Routine Immunization Programs and New Vaccine Introduction,” technically and financially supported by the Bill & Melinda Gates Foundation. The project encompassed six countries: Moldova, Uganda, Zambia, Honduras, Benin, and Ghana. A common methodological approach was defined for all countries.
In terms of methods, the study focused on the national routine immunization program and new vaccine introduction. We included health facilities that provide routine immunization services as well as district, regional, and central level administrative offices. For routine immunization we used costs for 2011, the last fiscal year available. National Immunization Days were outside the study scope. For NUVI costing, an incremental approach was adopted (i.e., additional activities and resources that would not have occurred if the new vaccines had not been introduced). 

A stratified random sampling approach was used for the district and facility selection (n=50). We organized our data collection and analysis to capture routine immunization costs by activity and inputs. The following activities related to routine immunization were included: routine facility based vaccine administration, outreach vaccine administration, record-keeping, surveillance, supervision, training, vaccine collection/distribution/storage, and cold chain maintenance. Both specific immunization program and shared health system costs were included, and capital (cold chain equipment, vehicles, buildings) and recurrent inputs (vaccines, salaried labor, volunteer labor, fuel, overheads) accounted for.

For each facility in the sample, we estimated total routine immunization facility costs combining expenditure data and information on quantities and prices for activities and inputs. The following costs were provided for the facility analysis: facility total cost, cost per dose, unit cost per fully immunized child (DTP3-HepB-Hib), cost per infant, and cost per capita. Costs were weighted based on the sampling procedure. Cost aggregation to estimate national routine immunization costs in both countries was calculated based on the estimated average at each level.